=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972777977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY T. ORYSZCZAK D.D.S., P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1522 HASLETT RD
-----------------------------------------------------
City | HASLETT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48840-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-339-9656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1522 HASLETT RD
-----------------------------------------------------
City | HASLETT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48840-8472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-339-9656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. GARY THOMAS ORYSZCZAK
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 517-339-9656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 11335
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------